Dr Camilla Fadel
Camilla is a clinical educator for the team with experience working in Psychiatry, Coaching in the trust and Relationship Counselling for a National charity across South London.
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I have had the privilege to work with clients in NHS Psychosexual Services over the last 12 months. In this space, a lot gets reflected on from psychoeducation on sexual response and arousal to what makes a good sexual experience for an individual. Sessions may focus on practical exercises, background relational experiences, communication tools, mindfulness, strategies around anxiety and pain- the list goes on. The area of work is truly holistic and within it the focus on identity often comes forward.

In this article I wanted to consider how to support a coming out conversation around LGBTQ+ identity with some tips from the therapy room. I am writing this in the perspective of themes so of help both when being recipient to the conversation, and when being the one Coming Out. I have included ten themed areas or tips, across three steps- basic understanding, skills that help us talk and where to next. Written on National Coming Out Day as symbolic for the topic naturally leads me to my first theme.

Basic Understanding

1. Coming Out is not a one-time event

While National Coming Out Day may come once a year, coming out is not a once a year and far from a once a lifetime event. In many respects it may be helpfully reframed as Coming Forward. Many people focus on the first conversation that may be had around LGBTQ+ identity but coming out happens each time an individual shares their identity. Appreciating that this is not a one-time conversation both provides awareness of the ongoing nature of this conversation – and how it may be stressful- and hopefully opportunity. It may be that someone has had a negative first experience of Coming Out, but understanding how this may be challenging may be an opening to reset the conversation later. Equally not setting the expectation of a one-off conversation acknowledges the reality of enabling many conversation spaces – and not placing the pressure that all things get discussed in one go.

2. Understanding concepts helps but don’t assume knowing from a term

LGBTQ+ terminology is ever expanding as language evolves to find new ways to explain different identities. For some a particular label may feel a comfort and a connection to part of themselves they could not previously explain. Yet knowing that language changes over time helps caution not feeling we know by hearing a term, and to check the meaning for an individual / yourself in explaining your identity. Knowing common assumptions exist between understanding around the differences of sexuality, gender and relationship identities and understanding these spectrums is a useful step away from any lettered identity. The genderbread person is a helpful resource to connect some clear delineation.

3. Coming Out meets other intersections

An early caution in approaching a coming out conversation is also to appreciate the uniqueness of every person’s background. Sexuality, Gender and Relational identity will also intersect with other parts of our identity- our age and generation, class and education, race and ethnicity, ability and disability, religion and spirituality. Appreciating the other layers of identity is important to consider how this conversation may be challenging and what support may mean.

Skills that help us talk

4. Optimising the Environment to talk is important

Whether the recipient, or the person sharing, modifying the environment so that the conversation is protected is important. Various factors come in to play including the time, space and setting. Aiming for a quiet place, that will not be interrupted and where no one is rushed / has time available are key, yet often forgotten, factors.

HALT is a helpful acronym to remember the basic tenants to ensure when having a meaningful conversation, one is not otherwise Hungry, Angry, Late or Tired. In any of these states it may be more difficult to discuss a concern as we are more anxious and our brain may switch more to the amygdala responding emotionally, rather than using our prefrontal cortex, the area of the brain that helps us to plan and make decisions.

5. Plan for vulnerability and offer compassion

In therapy it can be helpful to ‘talk about talking’ – considering what language and approach may make discussing a sensitive topic most available. When approaching this conversation, the same planning applies. In addition to setting a time to talk when not HALT, considering what may be difficult things to discuss can be helpful ahead of time. Keep a core aim for compassion, self-compassion and making a space that does not feel judgemental. There may need to be pauses and more than one occasion to talk, as above. Considering what factors may help one stay present, including techniques to help one’s emotional regulation- mindful breathing etc, can be beneficial.

6. Target careful communication

We often listen to talk rather than listen to understand. Rather than rush any part of the conversation it is most important to clarify rather than assume. Using ‘I’ statements rather than ‘you’ ensure that the conversation does not become defensive and is much more factual e.g., ‘I heard’ is truth- ‘you said’ may not be. Wherever possible paraphrase and check what is meant by terms that are not understood, as above.

7. Share and ask in a considered way

Sometimes when it has felt that one’s narrative has been held back for a long time there can be a feeling of pressure to share everything in one go. Similarly, the person recipient to the conversation may feel a pressure to ask questions. Caution to oversharing and asking exists. Having thoughtful considerations to one’s own personal boundaries is important, sharing in a stepped way as one feels comfortable /as feels available. On occasions where coming out may be to someone who shares a LGBTQ+ identity it is important to also consider as a recipient to the conversation what may or may not be helpful to share of one’s own personal journey. Considered sharing here is how one’s own story may be useful to the person coming out to you- and to be ever cautious to not assume from one’s own narrative that there is a knowledge for the other person’s experience, as per the many different intersections above. Simple checking on this may include ‘I experienced ‘x’ I’m wondering if this is something that also may be going on for you’

Where to Next

8. Acknowledging a Journey

The understanding that coming out may happen on multiple occasions is only part of the wider journey. As other intersections change and with time personal understanding of identity may alter. What may be a challenge now may be a celebration later- or a new challenge may emerge. The only certainty any of us have is change – acknowledging this and the space to revisit what coming out means can be helpful both as a conversation and as individual reflection.

9. Considering who knows and what support means

Confidentiality is a necessity in the counselling space – within the bounds of risk. Considering who knows the information shared and how the information may be shared in the future is important with a coming out conversation. If this conversation hasn’t been had it is a safety to assume no information has been shared with others and to signpost to talk to the individual if ever a question was asked by a separate person.

For one person support may mean a very different thing to another. Checking in/ advising what this looks like specifically can be helpful including setting a known time to speak again if wanted.

10. Allyship and other supports

Not all conversations set up well and unfortunately the reason for this article falls to a power and privilege gap and space where homophobia, transphobia- ‘LGBTQ+phobia’ exists. From aversity community sets itself as a saviour- considering where to next includes what wider supports may look like, signposting to networks and information.

The role of Allyship -individuals supporting those with less power and privilege against oppression- is an important focus for how we can pass forward support. This includes within the LGBTQ+ community the role to support individual areas of LGBTQ+ that one may not share and other minority areas as in the intersections above e.g., BAME backgrounds, poverty, disability etc.

Some supporting websites to also review for this part include

Stonewall – a charity supporting freedom and equity of LGBTQ+ identifying people-I make the link to their own information and resources page: Information and resources | Stonewall

NHS listed supports can be found here Help for mental health problems if you're LGBTQ - NHS (www.nhs.uk)

Genderbread person resource The Genderbread Person | A free online resource for understanding gender identity, gender expression, and anatomical sex.

Article author: Dr Camilla Tooley